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Small centrum ovale infarcts on diffusion-weighted magnetic resonance imaging
Kiminobu Yonemura1, Kazumi Kimura, Kazuo Minematsu
1Cerebrovascular Division, Department of Medicine, National Cardiovascular Center, Osaka, Japan. kyonemu@aol.com
Background And Purpose:
A small centrum ovale infarct (SCOI), caused by occlusion of the white matter medullary arteries, is often equated with a lacunar infarct. We sought to clarify the clinical characteristics of a SCOI visualized by diffusion-weighted MRI (DWI) compared with those of a small basal ganglia infarct (SBGI).
Methods:
Patients with a SCOI (SCOI group; n=38) or SBGI (SBGI group; n=68) < or =15 mm in diameter on conventional MRI and DWI were selected from 582 consecutive patients with acute ischemic stroke. Sex, age, neurological symptoms, vascular risk factors, emboligenic heart disease, arterial occlusive disease in the ipsilateral carotid system, and recurrent stroke within the initial 30 days were compared between the 2 groups.
Results:
Only 47% of SCOIs but 87% of SBGIs could be identified with the use of conventional MRI, whereas DWI could detect them all. Age, sex, and vascular risk factors were not significantly different between the 2 groups. The SCOI group had more frequently an abrupt onset of symptoms (63% versus 26%; P=0.0002), emboligenic heart diseases (34% versus 12%; P=0.0054), occlusive carotid and/or middle cerebral artery diseases (53% versus 19%; P=0.0004), and recurrent stroke (13% versus 1%; P=0.0216) but less frequently a classic lacunar syndrome (50% versus 81%; P=0.0009) than the SBGI group. On a multivariate analysis, both arterial and heart diseases were independently associated with the SCOI group.
Conclusions:
Symptomatic SCOIs detected by DWI may be associated with large-vessel and heart diseases and should be distinguished from lacunar infarcts.
Insights
Small centrum ovale infarcts (SCOIs) detected by diffusion-weighted MRI (DWI) are often linked to large-vessel and heart diseases. These findings suggest SCOIs should be differentiated from typical lacunar infarcts.
Area of Science:
- Neurology
- Radiology
- Cardiology
Background:
- Small centrum ovale infarcts (SCOIs) are often misclassified as lacunar infarcts.
- Medullary artery occlusion causes SCOIs, affecting white matter.
- Diffusion-weighted MRI (DWI) offers advanced visualization of brain infarcts.
Purpose of the Study:
- To differentiate clinical characteristics of SCOIs from small basal ganglia infarcts (SBGIs).
- To compare SCOIs and SBGIs using diffusion-weighted MRI (DWI).
Main Methods:
- 38 patients with SCOIs and 68 with SBGIs (<=15 mm) were selected from 582 acute ischemic stroke patients.
- Conventional MRI and DWI were used for infarct detection.
- Clinical symptoms, vascular risk factors, heart disease, arterial disease, and recurrent stroke were compared.
Main Results:
- DWI detected all SCOIs and SBGIs; conventional MRI detected only 47% of SCOIs and 87% of SBGIs.
- SCOI patients showed more frequent abrupt symptoms, emboligenic heart disease, ipsilateral arterial occlusive disease, and recurrent stroke.
- SCOI patients less frequently presented with classic lacunar syndromes compared to SBGI patients.
Conclusions:
- Symptomatic SCOIs identified by DWI are associated with large-vessel and cardiac diseases.
- Distinguishing SCOIs from lacunar infarcts is crucial for appropriate clinical management.
- Further research is needed to fully understand the implications of SCOIs.